{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:45:17Z","timestamp":1787755517209,"version":"build-2784847793"},"reference-count":7,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Case:<\/jats:title>\n                    <jats:p>A 20-year-old woman presented with recurrent bilateral shoulder instability concurrent with severe, treatment-refractory epilepsy. Imaging revealed glenoid bone loss of 25% to 28% and large Hill-Sachs defects bilaterally. Bone graft augmentation of the glenoid and infill of the Hill-Sachs defects was performed bilaterally. Perioperative neuromuscular paralysis of shoulder girdle muscles with botulinum toxin was performed to facilitate recovery. Both shoulders at 2.5 and 4 years, respectively, demonstrate excellent stability and radiographic union despite continued seizure activity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Perioperative neuromuscular paralysis with botulinum toxin may provide early graft protection after the surgical treatment of glenohumeral instability because of seizures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.cc.20.00688","type":"journal-article","created":{"date-parts":[[2021,11,11]],"date-time":"2021-11-11T15:00:23Z","timestamp":1636642823000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Perioperative Botulinum Toxin A in the Surgical Management of Seizure-Related Shoulder Instability"],"prefix":"10.2106","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9255-0805","authenticated-orcid":false,"given":"Matthew D.","family":"Edwards","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth H.","family":"Koontz","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3917-8634","authenticated-orcid":false,"given":"Gonzalo J.","family":"Revuelta","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan C.","family":"Edwards","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9556-6802","authenticated-orcid":false,"given":"Harris S.","family":"Slone","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3016-6370","authenticated-orcid":false,"given":"Shane K.","family":"Woolf","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,10]]},"reference":[{"issue":"4","key":"bib1-20240805","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1067\/mse.2002.124524","article-title":"Shoulder instability related to epileptic seizures","volume":"11","author":"B\u00fchler","year":"2002","journal-title":"J Shoulder Elbow Surg."},{"issue":"2","key":"bib2-20240805","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1007\/s00167-014-3161-8","article-title":"Bone loss in patients with posterior gleno-humeral instability: a systematic review","volume":"24","author":"Longo","year":"2016","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"issue":"11","key":"bib3-20240805","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1016\/j.jse.2015.04.008","article-title":"The management of recurrent shoulder instability in patients with epilepsy: a 15-year experience","volume":"24","author":"Thangarajah","year":"2015","journal-title":"J Shoulder Elbow Surg."},{"issue":"7","key":"bib4-20240805","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1191\/0269215504cr800oa","article-title":"Treatment of recurrent posterior dislocation of the shoulder in cerebral palsy by injection with botulinum toxin A into the M. subscapularis","volume":"18","author":"de Boer","year":"2004","journal-title":"Clin Rehabil."},{"issue":"191-3","key":"bib5-20240805","doi-asserted-by":"crossref","first-page":"e112","DOI":"10.2106\/JBJS.J.00419","article-title":"Use of botulinum neurotoxin injections to treat recurrent shoulder dislocations in a patient with severe epilepsy: a case report","volume":"93","author":"Givon","year":"2011","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib6-20240805","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.arthro.2003.11.036","article-title":"The inverted pear glenoid: an indicator of significant glenoid bone loss","volume":"20","author":"Lo","year":"2004","journal-title":"Arthroscopy."},{"issue":"1","key":"bib7-20240805","doi-asserted-by":"crossref","first-page":"e199","DOI":"10.3928\/01477447-20161006-06","article-title":"Glenoid reconstruction with distal tibia allograft for recurrent anterior shoulder instability","volume":"40","author":"Frank","year":"2017","journal-title":"Orthopedics."}],"container-title":["JBJS Case Connector"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.CC.20.00688","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:43:36Z","timestamp":1787751816000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.CC.20.00688"}},"subtitle":["A Case 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